Provider Demographics
NPI:1871512640
Name:WALSH, HEATHER GAYLE SUTTON (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:GAYLE SUTTON
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 SCRIPTURE STREET
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201
Mailing Address - Country:US
Mailing Address - Phone:940-535-5767
Mailing Address - Fax:940-898-0147
Practice Address - Street 1:2665 SCRIPTURE STREET
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3708
Practice Address - Country:US
Practice Address - Phone:940-535-5767
Practice Address - Fax:940-898-0147
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9539207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183046504OtherMEDICAID OTHER
TXP00470018OtherRAILROAD MEDICARE
TX183046503Medicaid
TXL9539OtherSTATE MEDICAL LICENSE
TX183046503Medicaid
TXL9539OtherSTATE MEDICAL LICENSE